Table 1 Coherence [6, 7]

‘Coherence’ is one of four core Normalisation Process Theory (NPT) constructs. NPT was developed to highlight that practices (including complex interventions) are ensembles of activity, and that implementing non-routine practices takes individual and collective work. As a middle-range theory (i.e. one designed to guide empirical enquiry in a particular aspect of the social world [41]), NPT is intended to be used flexibly to help explain how people get this implementation work done.

NPT’s core constructs cover the different work of implementation: coherence (work to make sense of the job that needs to be done), cognitive participation (the relational work of getting everyone who needs to be involved on board), collective action (working together to make it happen) and reflexive monitoring (working out the value of doing it).

The core construct of coherence (sense-making work) has four sub-constructs:

• Differentiation is about how easily those involved can see that an intervention is different from current ways of working

• Communal specification is about how well, together, those involved can build a shared understanding of what an intervention is for

• Individual specification is about how well those who need to be involved grasp what specific tasks and responsibilities they have when using an intervention

• Internalisation is about how easily those involved notice what value an intervention might bring to their work